1912181421 NPI number — COLON & RECTAL CENTER OF UTAH P C

Table of content: MEGAN ROGERS SEMANSKI FNP (NPI 1487116745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912181421 NPI number — COLON & RECTAL CENTER OF UTAH P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLON & RECTAL CENTER OF UTAH P C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912181421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
324 TENTH AVE
Provider Second Line Business Mailing Address:
#280
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84103-2853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-408-5930
Provider Business Mailing Address Fax Number:
801-408-5259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 E 3900 S STE 320
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84124-1350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-263-1621
Provider Business Practice Location Address Fax Number:
801-906-0556
Provider Enumeration Date:
12/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOSSART
Authorized Official First Name:
PETER
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
801-263-1621

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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